Sunday, 19 August 2012

CAMBODIA: unknown pyrexic illness

Disputes Arise Over Cambodia’s Killer Illness

PHNOM PENH, Aug 17 2012 (IPS) -
The deaths of dozens of Cambodian children in recent months from an
initially undiagnosed disease has highlighted the difficult balancing
act between informing the public and potentially provoking panic.On Jul. 4 the country’s Ministry of
Health and the World Health Organization jointly announced that they
were investigating an “unknown disease” that had killed 61 out of 62
children infected since April.
“The unknown disease starts with high fever, followed by respiratory
and/or neurologic symptoms with rapid deterioration of respiratory
functions,” the statement said.
Just over a week later, the MOH and WHO said that the cause in most
of the cases was a severe form of hand, foot and mouth disease (HFMD). A
majority of 31 samples obtained tested positive for enterovirus 71
(EV-71), which causes HFMD.
The controversy came after Swiss paediatrician Dr Beat Richner,
founder of the respected Kantha Bopha children’s hospitals, criticised
the WHO on Jul. 8, accusing it of causing panic “for nothing”.
Richner, who had first alerted the government to the disease that was
killing children admitted to his hospitals, was concerned about
comments the WHO had given the news agency Reuters that he felt were
“neither professional nor necessary.”
Richner wrote that the WHO had told the world there was a “new
mystery killer disease in Cambodia.” He said he had flagged the
possibility with health authorities that an enterovirus was the cause.
In an additional message later posted on Facebook, Richner said the WHO
in Cambodia should be closed.
Maria Concepcion Roces, an epidemiologist with WHO in Phnom Penh,
told IPS that the agency generally preferred to have a diagnosis before
releasing information, but in this case the media had approached the
agency with enquiries.
“We then decided with the Ministry of Health (that) we must say
something, so that people would not speculate,” she said, adding that
the ministry had requested WHO’s assistance with the investigation after
informing it of the illness on Jul. 1. “If we don’t say anything and
people hear rumours, then I think that is what may cause panic.”
Dr Richner also pointed out that of more than 75,000 patients treated
at Kantha Bopha outpatient stations in June, only 34 were hospitalised
because of the illness in question, stating that on a public health
level it was “not an alarming issue”. He cited dengue fever cases as a
particular concern.
Richner could not be reached for further comment.
Duane Gubler, professor in the Emerging Infectious Diseases programme
at Duke-NUS Graduate Medical School in Singapore, told IPS by email
that the response to the EV-71 outbreak was a “higher priority” because
the illness was initially undiagnosed.
“The MOH (Ministry of Health) and WHO were working blind at the time;
the etiology of the outbreak was not known and there were fatalities,”
he said. “Once the virus was identified, then the MOH can return to a
normal public health response.”
Gubler said health agencies often communicated confidentially before
making public announcements to ensure that accurate information was
disseminated without sparking panic or overreaction.
He said the media often exacerbated such issues through “irresponsible reporting”.
“In such events, for the good of the public, the press should be
provided accurate and up-to-date information so they can help public
health officials inform the public and prevent panic,” Gubler said.
Possible outbreaks of infectious disease are a matter of concern in
the region, which in the last decade has been hit with cases of severe
acute respiratory syndrome (SARS) and A(H5N1), commonly known as avian
influenza or bird flu. According to WHO figures, 21 people are known to
have been infected with avian influenza in Cambodia since 2003,
resulting in 19 deaths.
HFMD is a common infectious illness that often affects children, but
there is no specific treatment for it. The WHO says symptoms can include
fever, mouth sores and a rash with blisters on hands, feet and
buttocks, and patients usually recover within a week. However, in some
cases EV-71 can cause more serious, and potentially life-threatening,
symptoms.
Sok Touch, director of the MOH’s communicable disease control
department, told IPS it was “inevitable” that people would be concerned
when details about such an illness were released, but insisted that
keeping the public and other health authorities informed was crucial.
Shortly after the results of the investigation were announced last
month, local media reported that Cambodian authorities had closed
schools and kindergartens ahead of the mid-year vacation because of
concerns about EV-71.
Sok Touch declined to comment on the decision to close the schools.
The WHO’s Maria Concepcion Roces said that the agency did not make
recommendations regarding school closures, and left such decisions up to
individual states.
In a Jul. 27 update, the Ministry of Health and WHO said that 56
children of the original 61 investigated have died, and said the
authorities had identified nine additional cases of severe EV-71
infection, resulting in three deaths, among 533 HFMD cases reported.
Duane Gubler agreedthat there was particular sensitivity to
potential outbreaks of infectious disease in the region because today’s
“unprecedented urbanisation and globalisation” increases the likelihood
that exotic pathogens will spread from rural to urban areas.
“This is why WHO is much more proactive about outbreaks such as the
one in Cambodia that wasn’t immediately identified,” he said. “Rapidly
spreading epidemics such as SARS can threaten global economic security.”

No comments:

Post a Comment

Google+ Followers

Search This Blog

Followers

About Me

After service in the British SAS Regiment the author became a physician and then an orthopaedic surgeon.
He has held professorial positions in Canada, Vietnam and the United States, practiced and taught orthopaedic surgery in three continents and in several wars.
He has extensive experience as an expert witness in court. Somewhere along the way, time was found to operate a four hundred acre mixed farm, a one hundred seat restaurant and to obtain a licence as a flying instructor.
The author's books are available from bookstores, the publishers, or from on-line bookstores such as Amazon, Barnes and Noble, and Indigo/Chapters.
http://mclementhall.com